How should I talk to the patient?

How should I talk to a person who is in such a confused state (“psychosis”)?

Usually the more you know and understand the problems you have, the more willing you are to cooperate on treatment. If your friend/relative accepts that something is wrong – has insight – it’s important to help by finding out as much as possible.

There are booklets and other sources that can be of assistance. Some also take into account the needs of those who have diminished ability to concentrate because of the illness. It is important for the person affected to understand that he is ill and not that he is bad or weak.

There will always be people who refuse to accept that there is anything wrong with them. Unfortunately, this may be a part of having a psychotic disorder. Accepting that you are sick is not made easier by all the myths surrounding mental illness that are still prevalent in society. It can also be hard to accept an illness where no clear diagnostic tests are available, such as x-rays and blood tests – in addition, everything that has happened appears to be very real to the person. Do not deny the person’s perception of his reality, but say rather that it is not your reality, that you perceive these events as symptoms of an illness which can be treated and that the treatment will assuage the pain and fear. Be clear with the person that he is ill and not himself, and that what is being or was experienced is not really happening. At the same time you should recognise that to someone with a psychosis it must appear real.

It is also important to avoid discussing whether delusions or other symptoms are real or not. This is not helpful and only serves to focus attention on the delusion. If the topic comes up, don’t argue, but listen attentively so that you get an understanding of their present reality. That way you can more easily show sympathy or refer to it in discussions when the person in question is better. Many who have had a psychotic episode will claim that the feelings connected to the psychosis were important and real, even though in the psychosis these feelings take a distorted form.

Say “I hear what you’re saying, but I don’t share your view”.

How should I talk to others about this?

Mental disorders are not uncommon and are found in all families. During the course of two or three generations nearly all families will have the experience of a family member having a psychosis disorder. In other words, it is not about just us, but also “other people”. At one time these things were barely discussed. Today, fortunately, there is greater openness about mental disorders. Even so, this can be one of the most difficult things we do. We imagine that no one will understand. We imagine that if we mention the word psychosis, people will think of the erroneous stereotypes of killers and madmen that movies and the media sometimes portray.

The best and the smartest thing to do is to be as honest as possible. As a rule, people will understand, especially if you lay out the facts. Most of your close friends and relatives will probably already have the impression that something is up. By being honest, you have a chance to enlighten others in addition to yourself. You are also most likely to receive support from just those persons who can help in the process of getting better. Being secretive can make matters worse in the long run.

You will often be asked questions you cannot answer. Just be honest. Say “I don’t know how she will be in ten years” if this is what you think.

There will always be someone who does not accept what you say. The truth is too painful for them. Children, especially younger siblings, will often react this way. So will the person who is ill. They do not want to know, or will deny what you tell them. Do not pressure them or make a big deal of it. When the time comes, they will be able to accept the situation. If you can keep the subject open when talking to others, there will be an opportunity to ask questions when they are ready. It may be a good idea to underscore the fact that negative attitudes do not benefit anyone – especially the person who is not well.*